'One-stop shop' coordinates pre-surgery for heart valve patients

A diagnosis of heart valve disease usually begins a whirlwind series of pre-surgical tests that takes a patient from lab to radiology and visits between primary care physician, cardiologist and cardiac surgeon.

The Valve Clinic at Cape Fear Valley Medical Center was created to eliminate most of those trips by combining all that’s required in one place.

The concept is simple, said Tonya Carter, interim clinic coordinator and nurse practitioner. Instead of going to different places for lab work, EKG, echocardiogram or CT scan, and seeing a variety of health care providers, patients come to the clinic.

Carter calls the clinic a "one-stop shop" for heart valve patients to get their pre-surgical testing. No longer do patients who are often older and frail have to walk from one area to another in the hospital.

"It's reversed," Carter said. "Everyone now comes to the patient."

The clinic opened in January 2017 to operate one day a week. Carter has been the coordinator from the beginning. The rest of the week she works in an ICU.

With the support of local cardiologists and cardiac surgeons, the Valve Clinic was created to simplify the road to surgery. For these anxious patients, Carter becomes support and educator.

She explains to those reluctant for surgery that surgery is the only option: a diseased valve has to be replaced.

Most heart valve problems are discovered by the patient’s primary care provider who hears a murmur during a check-up. The patient is then referred to a cardiologist who verifies the need for surgery and refers the patient to a cardiac surgeon.

The decision for surgery begins a cascade of steps that must be taken. Carter coordinates those steps for the patient while keeping the various physicians informed of the progress.

Heart valve disease generally isn't caused by the lifestyle choices that affect most cardiovascular health, such as smoking, diet or lack of exercise, Carter said. Most heart valve problems are congenital, meaning a person was born with the condition, such as two cusps or leaflets instead of a normal three-leaflet valve, or are age related or due to infections or damage to the heart.

At some point, the valve doesn't work well anymore and must be replaced. Persons with a history of rheumatic disease as a child are prone to valve disease. The majority of valve disease occurs with the aortic valve, Carter said. However, the mitral valve can be affected as well.

The symptoms of heart valve disease can be vague and often misunderstood as normal signs of aging.

A person may get lightheaded or dizzy as their heart strains to pump blood through a narrow, barely functioning valve. Difficulty walking short distances, shortness of breath, heart palpitations, angina and no longer taking part in physical activities that the patient used to enjoy are also common symptoms.

"Someone takes a stethoscope and listens to the heart and hears a murmur," Carter said. "It's really important to have that primary care provider and get an annual physical. They are often the gatekeepers of your health. They hear the murmur and refer patients to cardiology."

The clinic's first patient had a similar story.

The 60-year-old man thought he had bronchitis. He was consistently short of breath with a persistent cough. The urgent care center provider agreed that it was bronchitis and gave him a prescription. When he didn't get better, he returned to the urgent care center, and the provider thought he heard a murmur.

The man was referred to a cardiologist.

There it was discovered that he had severe stenosis or narrowing of the aortic valve. Patients diagnosed with severe aortic stenosis are at risk for sudden cardiac death, so five days after diagnosis, he had surgery.

Recently this first patient and other patients visited Carter to show how much better their lives are.

"I love it when patients have their valve replaced," Carter said. "Their shortness of breath is relieved and they are often able to return to activities they enjoy. The biggest thing that patients are excited about is the decreased swelling in their legs."

Carter says the clinic has been so successful, that it's expected to expand beyond one day a week and possibly add assistance with other cardiac conditions.

"Our goal is to encourage physicians to refer any patient with all types of valve disease to the clinic to receive specialized care," Carter said.